1. In 2024, we will significantly expand access so that everyone who needs to see a dentist will be able to. This will begin with measures to ensure those who have been unable to access care in the past 2 years will be able to do so - by offering a significant incentive to dentists to deliver this valuable NHS care. We are introducing mobile dental vans to take dentists and surgeries to isolated under-served communities.
2. We will launch ‘Smile for Life’ - a major new focus on prevention and good oral health in young children, to be delivered via nurseries and other settings providing Start for Life services, and promoted by Family Hubs. We will also introduce dental outreach to primary schools in under-served areas, and take forward a consultation on expanding fluoridation of water to the north-east of England - a highly effective public health measure.
3. We will ramp up the level of dental provision in the medium and longer term by supporting and developing the whole dental workforce, increasing workforce capacity as we have committed to do in the NHS Long Term Workforce Plan, reducing bureaucracy and setting the trajectory for longer-term reforms of the NHS dental contract.

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• Community conversation: Share your experience of orthodontist and dentistry services

In the short-term, the authors argue that action must be taken to shore up the service as it currently exists, through measures like increasing the intervals between routine check-ups to a year; tempting dental therapists into the NHS from the private sector; providing incentives for local commissioners to provide mobile clinics and targeted work in schools and care homes; and investing in preventative care in children and young people.

In the longer-term, two ways forward are set out:

1. Improving the current model through a move to a fee-for-service payment model for low-volume, high-cost and complex procedures, combined with a shift to a needs-based approach like general practice through making use of patient lists following initial assessments; keeping more dentists in post through a student loans forgiveness scheme; and investment in public health including checks in schools.  
2. Adjusting the NHS offer either by expanding it with a huge injection of funding, which the authors note is unrealistic; or scaling back NHS dentistry to a minimum offer for patients. This offer may include universal access to emergency care, pain relief and check-ups with preventative work. Access to more extensive NHS dental services would be protected for older people and children. Coverage would be limited and means tested to ensure the service only targets those with the greatest difficulties accessing care. 

The report states that “even with extensive contract reform and the full use of new groups of staff, restoring universal access would cost billions each year”, much of which would pay for care that people are currently getting privately. It calls for an urgent imperative to provide enough access for a basic core service for children, older people and those who cannot afford private care. This would mean “removing some of the rights to NHS services which people currently enjoy in theory – but usually go without in reality”, the authors add. 

1. Ensuring all healthcare workers understand and promote good oral health, especially for children
2. Creating equal access to treatment
3. Addressing workforce and training issues to meet future demand

It also highlights that hospital dentistry needs to improve the way it records treatment and outcome data.

You will need a FutureNHS account to view this report, or you can watch a short video summary which includes key recommendations.

• Lower team authority gradients - anyone can speak up if concerned irrespective of grade or position
• Improve situational awareness - ask the team to confirm the tooth (teeth) to be extracted
• Avoid miscommunication error: if there is potentially conflicting information (often in relation to molar teeth), seek advice from the prescribing practitioner or another colleague if possible
• Check and double-check radiographs, consent, and clinical examination findings
• If in doubt, do NOT proceed.